Relative risk estimate in HEAT for walking

To identify epidemiological studies that provided risk estimates for walking on mortality, a review was carried out, based on the US Physical Activity Guidelines Advisory Committee Report (2008), with additional searches conducted for more recent publications. The review covered studies that specified walking as a separate behaviour and reported a risk for mortality. In addition, advisory group members were asked to report additional studies. Fifteen studies were identified which reported an association between walking and reduction in all-cause mortality One of these was a well-conducted and recent meta-analysis of associations between walking and all-cause mortality as well as cardiovascular disease (Hamer and Chida, 2008). The following 9 studies on mortality among comparable populations identified in the review had controlled in the analysis for other types of physical activity:

  • +Gregg, 2003
  • +Hakim, 1998
  • Landi, 2008
  • Lee, 2000
  • Smith, 2007
  • Stamatakis, 2009
  • +Stessman, 2000
  • Sun, 2010
  • +Wannamathee, 1998

+: included in Hamer and Chida (2008)

In a meta-analysis, these studies were combined to calculate an aggregated risk, weighted by sample size. The resulting relative risk estimate was 0.78 (95% confidence interval: 0.64-0.98) for a walking exposure of 29 minutes seven days a week.


  • Gregg et al.; Relationship of changes in physical activity and mortality among older women; JAMA; 289:2379-86; 2003
  • Hakim et al.; Effects of Walking on Mortality among Nonsmoking Retired Men; N Engl J Med; 338(2): 94-9; 1998
  • Hamer and Chida; Walking and primary prevention: a meta-analysis of prospective cohort studies; Br J Sports Med; 42(4):238-43; 2008
  • Landi et al.; Walking one hour or more per day prevented mortality among older persons: Results from ilSIRENTE study; Prev Med; 47(4):422-426; 2008
  • Lee et al,; Associations of Light, Moderate, and Vigorous Intensity Physical Activity with Longevity: The Harvard Alumni Health Study; Am J Epidimiol; 151(3):293; 2000
  • Physical Activity Guidelines Advisory Committee; Physical Activity Guidelines Advisory Committee Report, 2008; Washington, DC: US Department of Health and Human Services; 2008
  • Smith TC et al.,; Walking decreased risk of cardiovascular disease mortality in older adults with diabetes; J Clin Epidemiol; 60(3):309-17; 2007
  • Stessman J et al.; The effects of physical activity on mortality in the Jerusalem 70-Year-Olds Longitudinal Study; J Am Geriatr Soc; 48:499-504; 2000
  • Sun et al.; Physical activity at midlife in relation to successful survival in women at age 70 years or older; Arch Intern Med; 170(2):194-201; 2010
  • Stamatakis et al; Physical Activity, Mortality, and Cardiovascular Disease: Is Domestic Physical Activity Beneficial? American Journal of Epidemiology, Volume 169,┬áNumber 10, 15 May 2009 , pp. 1191-1200(10)
  • Wannamethee et al.; Changes in physical activity, mortality, and incidence of coronary heart disease in older men; Lancet; 351:1603-8; 1998
  • Paul Kelly, Nick Cavill, Charlie Foster, Oxford University, June 2010


Development of guidance and a practical tool for economic assessment of health effects from walking. Consensus workshop. Background document: Summary of literature reviews and issues for discussion.
1-2 July 2010, Oxford, United Kingdom.